ter Wolbeek, Maike, van Doornen, Lorenz J P, Kavelaars, Annemieke et al. · Pediatrics · 2006 · DOI
This study looked at how common severe tiredness is in teenagers and whether it's connected to depression, anxiety, and other symptoms seen in ME/CFS patients. Researchers surveyed over 3,400 teenagers about their fatigue, mood, sleep, and daily habits. They found that severe fatigue is quite common in adolescents—especially in girls—and that it often clusters with depression, anxiety, and ME/CFS-like symptoms.
This study demonstrates that severe adolescent fatigue is not rare and frequently co-occurs with depression, anxiety, and ME/CFS-related symptoms as an interconnected cluster. Understanding fatigue prevalence and its psychological correlates in healthy adolescents helps identify early markers and risk trajectories that may precede ME/CFS diagnosis, potentially enabling earlier intervention.
This cross-sectional study cannot establish causality or directionality—it does not prove that fatigue causes depression/anxiety or vice versa, nor does it confirm that adolescent severe fatigue inevitably progresses to ME/CFS. The study uses questionnaire-based fatigue assessment rather than objective biomarkers or the specific post-exertional malaise definition central to ME/CFS diagnosis, so findings may not directly represent clinical CFS cases.
About the PEM badge: “PEM required” means post-exertional malaise was an explicit required diagnostic criterion for participant inclusion in this study — not that PEM was studied, observed, or discussed. Studies using criteria that do not require PEM (e.g. Fukuda, Oxford) are tagged “PEM not required”. How the atlas works →
The first block is for the primary paper and is the citation you should use in research work. The atlas-snapshot line only applies if you are specifically referring to this atlas’s reading of the paper on the date shown.
Primary citation
ter Wolbeek, Maike, van Doornen, Lorenz J P, Kavelaars, Annemieke, & Heijnen, Cobi J (2006). Severe fatigue in adolescents: a common phenomenon?. Pediatrics. https://doi.org/10.1542/peds.2005-2575
BibTeX
@article{mecfsatlas-ter-wolbeek-2006-severe-fatigue,
author = {ter Wolbeek, Maike and van Doornen, Lorenz J P and Kavelaars, Annemieke and Heijnen, Cobi J},
title = {Severe fatigue in adolescents: a common phenomenon?},
journal = {Pediatrics},
year = {2006},
doi = {10.1542/peds.2005-2575},
note = {PubMed: 16740810},
url = {https://www.mecfsatlas.com/evidence/ter-wolbeek-2006-severe-fatigue},
}Atlas snapshot reference
ME/CFS Atlas. Generator v1 / Scanner v1.4 / policy v0.1. Accessed 2026-05-27. https://www.mecfsatlas.com/evidence/ter-wolbeek-2006-severe-fatigue
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